In Part 1, I introduced the problem of heart failure and the use of intravenous diuretics, the standard therapy to treat fluid overload in hospitalized patients.
Recently, the UNLOAD trial was published in the Journal of the American College of Cardiology. This study compared intravenous diuretics with aquapheresis, a new treatment for heart failure.
Aquapheresis -- also called ultrafiltration -- is a technique for removing excess fluid from the body. It involves the placement of an catheter in the bloodstream that continuously runs the patient's blood through a filter. Excess fluid is remove from the blood through this filter, and the blood is then returned to the patient. Up to half a liter an hour of extra fluid can be precisely removed from the body in this way. (This technique is different than dialysis, which also involves the removal of excess toxins from the body -- using the process of diffusion -- when the kidneys have failed.)
In the UNLOAD trial, two hundred patients with heart failure were randomized to receive either intravenous diuretics or aquapheresis/ultrafiltration. After 48 hours, patients receiving aquapheresis had the following results:
38 % greater weight loss over standard care
28 % greater net fluid loss over standard care
Equal improvement in dyspnea score (breathing)
Ninety days after hospital discharge, patients receiving aquapheresis showed
43% reduction in patients requiring re-hospitalizations for heart failure over standard care
50% reduction in the total number of re-hospitalizations for heart failure over standard care
52% reduction in emergency department or clinic visits over standard care
63% total reduction in days re-hospitalized for heart failure over standard care
This study suggests that aquafiltration is an alternative therapy for hospitalized patients with heart failure that may be more effective than standard therapy.